AMGA calls on Congress to end MIPS exclusions

An association representing multispecialty medical groups is urging Congress to implement the Medicare Access and CHIP Reauthorization Act and eliminate exclusions under the act's Merit-based Incentive Payment System that it says penalizes high-performing providers.

In a letter submitted to lawmakers Feb. 4, AMGA said it appreciates congressional passage of the act but outlined recommendations regarding this year's full implementation of its incentive payment system that would exclude many providers.

"MIPS was designed as a viable transition tool to value-based payment in the Medicare program, where providers would be rewarded for their investments in health information technology, care management processes and people," AMGA President and CEO Jerry Penso, MD, wrote. "However, the CMS has not implemented MIPS as Congress intended."

AMGA noted that the act was designed to shift payment from fee-for-service to value-based reimbursement, and providers participating in its incentive program may earn an annual positive or negative adjustment to their Medicare reimbursements based on performance. But the association said CMS has excluded about 60 percent of providers from the incentive payment system requirements, in effect penalizing high-performing providers.

"Because MIPS is budget-neutral, these exclusions result in insignificant payment adjustments to high-performing providers. For example, high performers are estimated to receive an aggregate payment adjustment in 2019 of 1.1 percent, compared to a potential 4 percent allowed under the statute," said Dr. Penso.

Overall, these payment adjustments "fail to reward providers for superior performance in the MIPS program and provide nominal return on investments," he said.